Applied nutritional investigationUsefulness of soluble dietary fiber for the treatment of diarrhea during enteral nutrition in elderly patients
Introduction
In the geriatric field, long-term parenteral nutrition recently was found to cause mucosal atrophy. In particular, nutritional management with semidigested formula is commonly used.1 However, the administration of semidigested formula has been reported to induce small intestinal mucosal atrophy or the enhancement of intestinal tract permeability, because such a formula has low residue.2, 3 Problems such as diarrhea and loose stools are especially common. In general, strategies to prevent the development of diarrhea after the administration of enteral nutrients have included appropriate nutrient administration methods such as the regulation of the administration rate, concentration, temperature, and medication. In recent years, some studies have reported that the addition of dietary fiber helps normalize digestive function and prevent diarrhea.4, 5, 6 However, the efficacy of such additional dietary fiber has not been examined in detail.
In this study, to improve small intestinal mucosal atrophy, we administered soluble dietary fiber to elderly patients in whom oral ingestion was impossible, and where small intestinal mucosal atrophy had developed during long-term parenteral nutrition so as to cause mucosal atrophy, thus resulting in loose stools or diarrhea.
The clinical usefulness of soluble dietary fiber was examined by measuring the serum diamine oxidase (DAO) activity, which is an index of the morphologic change in small intestinal mucosa, fecal features, the frequency of bowel movements, the water content of feces, fecal pH, and fecal short-chain fatty acid (SCFA) levels; in addition, we examined the intestinal flora. Various serum biochemical parameters and oligodynamic trace minerals were also examined as nutritional indices.
Section snippets
Subjects
This study was based on an investigation of 20 elderly inpatients (10 men and 10 women; mean age ± standard deviation: 79.3 ± 5.1 y) at the Nagoya University Hospital Geriatrics Department who had no organic disorders of the digestive tract, had been bed-ridden for a prolonged period due to cerebral infarction or cerebral hemorrhaging, and demonstrated loose stool or diarrhea. In these patients, semidigested formula (Ensure Liquid, Dainabot Co., Ltd.) was administered with the use of a
Results
In 20 patients, the mean serum DAO activity before administration of the fiber was 8.54 ± 0.16 IU/L, which was significantly lower than in control subjects (10.0 ± 1.5 IU/L). Serum DAO activity increased significantly between 2 and 4 wk after administration (P < 0.001) but decreased significantly 1 and 2 wk after discontinuation compared with DAO activity 4 wk after administration (P < 0.001; Fig. 1).
The water content of the feces decreased serially compared with that before fiber
Discussion
Hosoda et al. conducted an animal experiment and reported that intravenous hyperalimentation and nutritional management with certain kinds of enteral nutrients and non-physiologic component nutrients cause atrophy of the digestive tract mucosa, whereas the administration of dietary fiber prevents atrophy of the mucosal epithelium.10 Because the soluble dietary fiber product used in our clinical study, Healsh Fiber, is liquid, this preparation can be easily and evenly mixed with other enteral
References (22)
- et al.
The effects of total parenteral nutrition on gastrointestinal growth and development
J Ped Surg
(1985) - et al.
Sensitive colorimetric assay of serum diamine oxidase
Clin Chim Acta
(1994) - et al.
Galactosylsucrose and xylosylfructoside alter digestive tract size and concentrations of cecal organic acids in rats fed diets containing cholesterol and cholic acid
J Nutr
(1994) - et al.
Structural and functional alterations in the gut of parenterally or enterally fed rats
J Surg Res
(1989) - et al.
Kinetic studies on the metabolism of short chain fatty acids and glucose by isolated rat colonocytes
Gastroenterology
(1994) - et al.
Reversal by short-chain fatty acids of colonic fluid secretion induced by enteral feeding
Lancet
(1993) - et al.
Determinants of decreased fecal consistency in patients with diarrhea
Gastroenterology
(1995) - et al.
Mineral retention in young men consuming soy-fiber-augmented liquid-formula diets
Am J Clin Nutr
(1988) - et al.
Influence of intact and partially hydrolysed guar gum on iron utilization in rats fed on iron-deficient diets
Comp Biochem Physiol
(1994) - et al.
Tube feeding for the elderly
Can Nurs Home
(1992)
Microorganisms and diarrhea in enterally fed intensive care unit patients
JPEN
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